title: Tolerance to alternative cyclooxygenase-2 inhibitors in nonsteroidal anti-inflammatory drug hypersensitive patients.
abstract: BACKGROUND
  Non-steroidal anti-inflammatory drugs (NSAIDs) frequently cause adverse drug reactions. Many studies have shown that drugs which selectively inhibit the cyclooxygenase-2 enzyme (COX-2) are safe alternatives in the majority of patients. However, hypersensitivity reactions to COX-2 inhibitors have been published. Hardly any data are available regarding the safety of alternatives in case of COX-2 inhibitor hypersensitivity. We aimed to investigate the tolerance to COX-2 inhibitors in patients with non-selective NSAID hypersensitivity. Furthermore, in COX-2 hypersensitive patients tolerance of a second COX-2 inhibitor was investigated.
  
  
  METHODS
  We retrospectively analyzed 91 patients with proven non-selective NSAID hypersensitivity that underwent oral challenges with a COX-2 inhibitor. Patients with intolerance to the first challenged COX-2 inhibitor received a second challenge with a different COX-2 inhibitor.
  
  
  RESULTS
  19 out of 91 (21%) patients had a positive reaction to the first oral challenge with a COX-2 inhibitor. 14 of them underwent a second challenge with a different COX-2 inhibitor and 12 (86%) did not react.
  
  
  CONCLUSIONS
  A relatively high percentage (21%) of the non-selective NSAID hypersensitive patients did not tolerate a COX-2 inhibitor and oral challenge is advised prior to prescription of a COX-2 inhibitor. For the majority of patients reacting to a COX-2 inhibitor an alternative can be found.
authors.affiliation: Department of Dermatology/Allergology, University Medical Centre Utrecht, Heidelberglaan 100, G 02,124, Utrecht 3584 CX, The Netherlands. h.rockmann@umcutrecht.nl.
authors.forename: Wendy Sj
authors.initials: WS
authors.lastname: Malskat
authors.forename: André C
authors.initials: AC
authors.lastname: Knulst
authors.forename: Carla Afm
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.forename: Heike
authors.initials: H
authors.lastname: Röckmann